MEDICARE: ROBERT J BRECHER PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	112	DE

General Provider Information

NPI Number	:	1164877676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT J BRECHER PSYD

Provider Business Mailing Address
First Line	:	55 HATCHETTS HILL RD
Second Line	:
City	:	OLD LYME
State	:	CT
Zip	:	06371-1534
Country	:	US
Telephone Number	:	800-370-3651
Fax Number	:	877-515-7147

Provider Business Practice Location Address
First Line	:	2711 CENTERVILLE RD
Second Line	:	SUITE 400
City	:	WILMINGTON
State	:	DE
Zip	:	19808-1660
Country	:	US
Telephone Number	:	800-370-3651
Fax Number	:	877-515-7147

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2016
Last Update Date	:	05/03/2016

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